It is essential to determine the vascular status of the foot; findings will largely influence ulcer management, determine the likelihood of wound healing and identify the need for revascularisation3,6,7 recommend: Palpation of foot pulses —palpation of dorsalis pedis and posterior tibial pulses should be undertaken If pulses are not palpable or arterial disease is suspected, other tests such as Doppler examination and ankle: brachial pressure index (ABPI) should be undertaken.
Determining whether the patient is experiencing vascular symptoms, for example, intermittent claudication (i.e. pain in the calves on walking) or rest pain( constant pain in the feet and legs aggravated by lying flat or the warmth of bed clothes. If there is concern of significant peripheral arterial disease, expert advice from the vascular team should be sought. Efforts should be made to manage arterial risk factors in those who have suspected poor blood flow. Certain factors are known to increase the risk of arterial disease, for example, high blood pressure and high cholesterol.
These factors should be identified and management strategies that aim to minimise arterial risk factors introduced. The IDF6,7 recommend attention to blood pressure, dyslipidaemia (abnormal lipid levels in the blood) smoking cessation and the use of anti-platelet agents such as aspirin.